Oral mucosal melanoma: a malignant trap

Abstract

Oral mucosal melanomas are highly malignant tumors. The 'chameleonic' presentation of a mainly asymptomatic condition, the rarity of these lesions, the poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health provider. We present the case of a 75-year-old man who was referred to the Ear, Nose and Throat department. His symptoms were voice alteration and saliva drooling, progressively worsening during the last few weeks. The absence of pain was the reason for the delay of seeking medical care. The diagnosis was an oversized oral melanoma. This is an example of how the time of diagnosis and the evolution of a disease could be seriously influenced by patient's behavior. Melanomas arising from oral mucosa have poor prognosis unless they are discovered and treated early. The vigilance of the physicians is necessary to have success in this difficult task.

Figure 1

Photograph at initial examination showing an oversized pigmented soft mass (melanoma) arising from the palate.

Figure 2

Tissue sections revealed extensive infiltration of the mucosa by neoplastic predominantly epithelioid cells, in a solid, nested, trabecular or alveolar pattern. Continuity of the tumor with the surface epithelium was identified (Haematoxylin and Eosin stain, magnification ×100) (A). The neoplastic cells demonstrate strong immunoreactivity for Melan A monoclonal antibody (magnification ×200) (B).

Figure 3

A computer tomography with contrast revealed a large palate's mass, which is seemed to infiltrate the left medial pterygoid muscle.